Do Your Chest and Ribs Hurt? The Culprit Could Be Psoriatic Arthritis
Psoriatic arthritis can sometimes lead to chest or rib pain. Blame costochondritis, an inflammation of the cartilage connecting the ribs and the breastbone.
Chest pain sometimes indicates heart disease, but sometimes it doesn’t: It can be a symptom of a number of different conditions — and there's no simple way to know what the problem is without seeing your doctor.
The Problem Could Be Musculoskeletal
For people with psoriatic arthritis, “perhaps the most common type of chest pain is?costochondritis," says?Adam Kreitenberg, MD, a?rheumatologist?in Los Angeles. Costochondritis is inflammation of the cartilage connecting the ribs to the breastbone (sternum). “This chest or rib pain can be quite severe and cause pain with deep breathing, physical activity, and even coughing or sneezing,” Dr. Kreitenberg says. You might think you’re having a heart attack.
Doctors typically diagnose costochondritis with a physical exam, feeling (palpating) the areas where the ribs attach to the sternum. “While X-rays and bloodwork are often not necessary, they can be helpful in ruling out other and potentially more severe diagnoses, such as heart attack,” says Kreitenberg.
According to the Arthritis Foundation, psoriatic arthritis is a type of spondyloarthropathy, an umbrella term for inflammatory diseases that involve both joints and entheses (the sites where ligaments and tendons attach to bones).?Up to 70 percent of people with PsA have peripheral and spinal inflammation, but people with a type known as axial PsA have arthritis only in the spine. The most common axial PsA symptoms are?morning back or neck stiffness that lasts longer than 30?minutes, and neck or back pain, notes the Journal of the American Academy of Dermatology.
What’s the Best Treatment?
Treatment for chest and rib pain caused by costochondritis may include therapy for the underlying psoriatic arthritis, such as?disease-modifying antirheumatic drugs (DMARDs)?and?nonsteroidal anti-inflammatory drugs (NSAIDs).?NSAIDs?include?ibuprofen (Advil),?naproxen (Aleve), and diclofenac (Voltaren). “It may also include biologics. Ask your doctor about the right medicine for you, and get an accurate diagnosis,” says Rajat Bhatt, MD, a rheumatologist in Richmond, Texas.
Heart Disease May Be the Cause
If you have psoriatic arthritis and experience chest or rib pain, the problem could in fact be heart disease. A study published in May 2021 in the Journal of Internal Medicine found that “both psoriasis and PsA were associated with an increased prevalence of coronary calcification. Psoriasis patients also showed an increased prevalence of severe calcification.”
“Patients with chronic autoimmune inflammatory conditions may have high levels of circulating inflammation throughout their bodies, which places them at increased risk of cardiovascular disease,” Kreitenberg explains. “Therefore the classic chest pain associated with?a heart attack?should be closely monitored.”
Dr. Bhatt points out that cardiac complications can sometimes come from certain PsA medications. “Some of these medications can cause thromboembolism and pulmonary embolism (blood clots in the lungs). JAK inhibitors, for example, can cause the latter,” he says.
Pay particular attention if you also experience breathlessness, pain or numbness in your legs or arms, or cough, fever, or swelling in the legs.
Heart Disease Treatment
If the cause of the pain does turn out to be heart disease, get seen by a doctor in person and go to the ER. You may need to be admitted to the hospital for further management. If you aren’t already doing so, you might need to start taking aspirin, begin cholesterol lowering therapy, and make dietary changes and other interventions, says Bhatt.
Look for These Other Symptoms
If you are experiencing chest and rib pain as a PsA patient, Bhatt advises you to watch out for these other symptoms, which could indicate something more than heartburn is happening.
- Skin rash
- Swollen joints
- Weak and pitted nails. In some cases, the nails actually peel off.
- Low back pain
- Floaters or painful redness in the eyes
- Diarrhea or constipation
- Gastroesophageal reflux
Other Possible Causes
Chest pain in people with PsA can also be caused by:
- Another organ system being affected by PsA
- Chronic pain syndrome
- Side effect of non-aspirin NSAIDs, which can increase the risk of heart attack, as the U.S. Food and Drug Administration (FDA) notes
No matter the cause, it’s important to get any chest pain checked out. As Bhatt says, “Chest pain should not be taken lightly. Err on the side of caution and contact your doctor as soon as possible to distinguish the various causes.”